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Comment by silisili | Hacker News Reader

This isn't at all surprising, for multiple reasons. The entire insurance industry existing is a big one. That we are all overweight is another.

I'm generally a very conservative person. But even I am for government funded healthcare. Who in the hell is against it? I've not met a single person completely against it, mostly just people against people abusing emergency rooms.

Certain big media and politicians are against it, saying we have the best in the world and often pointing at waiting lists in other places. My last gastro had a 7 month waitlist. What in the hell am I paying a fortune for every paycheck, then?

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Private insurance doesn't have to be bad. Netherland has private insurance, and it works fine. Admittedly we've got probably the most expensive healthcare system in Europe, but it's still about half of what the US pays. But it does need to be tightly regulated, and more importantly, the healthcare system itself needs to be regulated. There needs to be a drive to lower costs while increasing quality. And of course the insurance company needs to take care of the costs. I see far too many stories about people having to fight their own insurance company.

The real fundamental problem I think is that the US healthcare system is primarily run for profit, and not for the health of the people. Both by insurance companies (who strongly resist paying), and by hospitals and other healthcare providers (who love to spring unexpected costs on you). That's the primary difference between the US and Dutch systems.

>Netherland has private insurance, and it works fine.

Fine-ish. For example some medications are not available because the insurance companies decided they would pay only for the cheapest generics and then only the lowest prices of anyone. For some reason this means that manufacturers decide to only supply to the Netherlands when they have ample supply.

Also there are the inefficiencies of the insurance companies who are for profit entities that spend large ammounts of money on their executive teams and ad campaigns to convince people to switch their policy to a difference insurer.

That's why I said fine, not great. There's tons of room for improvement, but it's not the disaster that the US health care system is.

But obviously any system that involves for-profit companies with executives and shareholders is going to siphon some money out of the system. I don't doubt socialised healthcare systems are fundamentally cheaper, and if done well, at least equal in quality. I'm just saying it's not just the privatised nature that's crippling the US system; it's certainly not helping, but it's aggravated by being a particularly poorly implemented privatised system that's entirely about profit and doesn't really care about the people it's supposed to help.

And let's not fool ourselves; there are also wrong ways to do socialised healthcare. I do think socialised is generally better, but you always have to look critically at all the parts of the system.

It may not have to be bad but it is absolutely an unnecessary siphon of funds out of the healthcare system. Simply put every single ass in a seat at an insurance company is $N not being spent on providing actual healthcare.

Some administrators are going to be necessary to run any sort of healthcare system. Just as an example, someone has to prepare and send each doctor a W-2 every year.

Ok so are we now pretending hospital administration staff doesn't already exist? Or that the simple majority of employees in Dr's offices aren't there solely to process insurance claims? So again, for the cheap seats, insurance companies: 100% overhead, 0% healthcare provided.

Good point. Not sure what I was thinking when I wrote that. No insurance adjusters around, nobody needs to issue them paychecks.

In David Graeber's book "Bullshit jobs", there's a quote from Barack Obama saying that strongest argument against overhauling the US health system is the millions of lost jobs from the insurance and adjacent industries. So there seems to be your answer, from the horse's mouth.

The Insurance industry is a bug vampire squid sucking money out of the system, and ironicly stopping many from getting the health outcomes they need.

A small group chat I’m a part of has one person who works for an insurance company. Reading his messages about his work day is just depressing.

“Oh, yeah, if someone has that cancer and they’re under 45 it’s an auto-reject from me. Just too unlikely for them to have it” was one message that’s stuck with me. You (or your company) pays thousands of dollars a year (or more) to an insurance company to cover you for when the worst things happen—and despite you or your doctors trying to get your shit together, somebody chilling 1500 miles away skims your report and auto-declines any form of coverage just because it seems unlikely. Then it’s an uphill battle of trying to not only battle your illness and your daily life, but a company that has employees with worse judgement than an AI thrown together by some dude on Twitter in a weekend.

It’s disgusting to think about.

how.... how... can they reject anything that the hospital says?

Because they are allowed to. Having no (useful) regulation allows that and more. And no it's not abuse, it's the system working as designed. If there's a problem with it, don't take it with the people in the system, as tempting as it might be. They will be replaced by others with the same reject-happy finger. It needs a new system, heavily regulated like in Europe, and this means exactly the uphill battle you would expect.

Propublica just ran a good article on UHG's attempts to deny coverage to a university student with severe ulcerative colitis. Apparently the insurer has its own panels of MDs that it can deploy to lobby the patient's doctor into different courses of treatment. In this case, UHG staff completely fabricated statements from the patient's doctor in order to justify reducing care to an ineffective level. https://www.propublica.org/article/unitedhealth-healthcare-i...

They are not rejecting what the hospital says. I imagine pigsty’s account is missing some nuance, such as an uncommon diagnosis or prescription requiring further proof. The doctor might think (and might very well be guessing correctly), but the protocols require a certain level of evidence that was not provided.

It could also be malfeasance, but I doubt that is happening on a systemic level at the big health insurance companies. They benefit from more healthcare spending, so I do not see why they would want to tamp down on necessary expenses.

They are rejecting on the presumption that the billing is erroneous. The hospital would follow up and get it approved. It’s a crude system and I’m not excusing it.

You understand that if the Insurance industry didn't exist we would just re-create it right? I mean, if you tell people they can spend any amount of money on healthcare they will bankrupt whatever pot of money is available. You're just suggesting we go from saying the Insurance industry is terrible to saying whatever Government agency is running healthcare is terrible.

Read about how doctors and patients talk about Medicaid, Medicare or Tricare. If you say they're popular I'd agree with you - but you need to see what people say when they're asked if they like their own private insurance; generally that's popular too. Most people like whatever health insurance they have most of the time because insurance only pinches in edge cases - not when I'm healthy and only in the subset of sick case called "I want a treatment that my insurance won't pay for." Those cases are always going to happen and sometimes it will be for legitimate reasons.

> I'm generally a very conservative person. But even I am for government funded healthcare. Who in the hell is against it?

I'm European but there are major issues with waiting times, terribly low wages, strikes, ambulance provision, etc. in almost every country I've lived in.

Overall I think public healthcare is well worth it - in theory you can save a lot with one central purchaser, and even moreso if the government was willing to do drug discovery and production directly too.

But it is difficult to ensure future governments don't ruin it. It's kind of like why the unemployment funds and minimum wage negotiations being in the hands of trade unions instead of the government has worked out better in Sweden.

In US there is also major issues with waiting time. Like months for anything non-emergency. And emergency is just partially covered by an insurance anyway, so it doesn't really count. Also an Uber instead of ambulance.

Not sure about the wages and strikes though. But considering the fact that our neighbor doctor is a member of a yacht club, and the landlord who is another doctor had invested in a bunch of apartments that he lost the track of them, I guess they are fine.

The entire insurance industry, and almost all of the industries who make money from it, are against it, for one. There are many doctors and nurses who would also be incensed if you told them that they had to take less pay EVEN IF you also immediately eliminated all their education debts. Nurses in particular are heavily incentivized to work overtime because they usually work insane 12 hour shifts to begin with.

You also can't reform it if you aren't going to touch the pharmaceutical industry. There are medicines that cost $3K a month here that cost $0.50 in Africa for the same dosage. I can understand that the US is funding the military to a ridiculous degree to maintain its global hegemony... but I can't understand why voters think it's a good idea to allow pharmaceutical manufacturers to gouge the crap out of people.

Nothing about medical care is a traditional manufacturer / consumer relationship. I'd rather nationalize the pharma companies and all medical patents for medicines or devices which are sold more than a factor of 5x in the US over its lowest price.

Is the long-run alternative that future medicines like that are available for $0.50/month worldwide or not available at all?

> many doctors and nurses who would also be incensed if you told them that they had to take less pay EVEN IF you also immediately eliminated all their education debts

If the reduction in current value of their lifetime pay is greater than the value of their education debts, why wouldn’t they be incensed? I would be as well, as would most people.

> Is the long-run alternative that future medicines like that are available for $0.50/month worldwide or not available at all?

Not if the government nationalizes the pharmaceutical industry and treats it like NASA, which it should have done a LONG time ago.

> If the reduction in current value of their lifetime pay is greater than the value of their education debts, why wouldn’t they be incensed? I would be as well, as would most people.

Hospitals are overworking medical staff. The average nursing shift is 12 hours long. Most surgeons are putting in 60+ hours a week. The number of medical staff needs to increase and their work hours need to be normalized as much as possible. We've allowed medical associations to artificially gatekeep the populations of staff for no damned good reason.

> That we are all overweight is another.

https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...

Obesity vs overweight (the former is surely a better predictor of health outcomes anyway) aside, we’re definitely higher than comparable nations, but I wouldn’t say significantly so.

Yes you are, especially when it comes to the "landwhale" category of 400+ pounds.

Even the link you provided says that the US would fit among the Arab countries, but would be a major outlier in Europe. There are people with bellies here, BMI > 30, but the "unable to walk without a motorized wheelchair" category is rare.

I live in the Czech Republic, a notorious beer-guzzling nation that was never known for being slim. But the kind of obscene, ballooning fatness that is ubiquitous in the US was never seen here until, say, 2015. Unfortunately I slowly see it slowly emerging among the youth, probably the ones who live on the fastfood diet.

(Fast food used to be relatively expensive compared to Czech salaries, so people wouldn't gorge on it everyday, but this has changed and now it one of the cheaper options out there.)

If you're looking at large countries (>5M) with genetically diverse populations, it's #1. That the top 10 are all smaller countries primarily populated with those with pacific islander/Polynesian backgrounds is remarkable though. Hard to argue there's not something genetic going on there, though apparently there is a cultural preference for larger body size (equating it with material wealth) in at least some such countries. It's presumably also the reason NZ has measurably higher obesity rates than we do in AUS. Perhaps surprisingly the US is only #20 on the list of countries sorted by average BMI, and not that much higher than NZ (or even AUS). I haven't been to the US in well over 10 years now but perhaps we're just playing catch-up here, as at the time I remember being shocked just how many people with truly massive bodies seemed to be commonplace in a way I'd never observed back home.

Having said all that, I happen to know there's a school of thought that many (if not most) of the health issues supposedly "caused" by being overweight are largely an artifact of health professionals being so focused on their patients' weight that they fail to diagnose other health issues early on, or that patients no longer feel comfortable speaking to their doctors etc. The fact that the stats on diabetes/stroke/heart failure etc. correlate so strongly with obesity across such a large range of countries, even those where apparently "fat shaming" isn't a thing, leads me to be somewhat skeptical of that POV.

Definitely an interesting read, though I'd counter that 30% higher in the US than in the UK feels significant (36.2% versus 27.8%).

For extra context, the UK has a higher rate of obesity than any EU country. So the US is a definite outlier amongst advanced economies.

The trick is to spread consumerism ads and fastfood chains all other the world, such that this list doesn't show a big difference. If you manage to pollute everyone else fast enough, statistics can be blurred to a point where there is obviously no reason to act.

Did that already. There's a pizza hut within line of site of the Great Pyramids at Giza.

> Who in the hell is against it?

Roughly half the country is against it! And ironically, it's often because they want "choice" in their medical care, despite the fact that health insurance is tied to your employment and you barely have any choices under your control anyway -- you go with the clinic or hospital that takes your plan, and you go with the doctor that's available.

It's such a complete lie that our current system confers any advantages whatsoever. It's a line trotted out by insurance lobbyists, then politicians, then shitty news media, and finally by the poor brainless voters themselves.

If Americans had any international perspective at all it would be much harder to keep that fiction alive, but Americas generally are completely ignorant of how people live outside the us, and not interested in finding out.

The US has lower wait times and substantially better cancer treatment than most comparison countries, including Canada and the UK. Entire categories of specialist cancer treatment are simply not available in Canada.

No advantages whatsoever? That would be a plausible argument if Canadians didn't seek treatment in the US in record numbers, growing by over 20% a year.

From the international perspective, US is probably closer to the EU than to, say, France or Britain, (both in size and in relative decentralization), and we do not have a common healthcare system in the EU either - plus there seems to be even less support for it than in the US.

Actually, Americans are ignorant of the outside world, but not in the way that you're painting. They generally think that Europe has socialized single-payer healthcare, which is mostly not true (a few European countries, like the UK, do, but most have an insurance-based system). They also think that most of the world has access to the quality of care that people do in the US (nope). They also think doctors and nurses get paid the same outside the US (far from it.) They think that government healthcare means that there will be nobody to say no to expensive procedures (very untrue: there will always be a bureaucrat scrutinizing how much is spent on a patient).

The media promotes all of these myths, with the eventual goal of a complete government takeover of health care.

We can add one bonus myth here too: the idea that the US healthcare system leaves people to die if they have no money and no insurance. Nope! If you show up at any emergency room, they cannot refuse treatment. And of course, getting insurance for the poor or lower-middle class is easier than ever due to Obamacare.

So while it's far from a perfect system, it's a lot better than the media paints it as. And the government alternatives are not utopian. See https://www.theguardian.com/society/2022/mar/02/private-heal...

I literally watched a dude die waiting to be seen in an ER in the US. They are absolutely required to treat but nobody said anything about how they prioritize patients when the ER is busy. Some more news for you, you can't waltz into the hospital with any number of chronic or life threatening conditions and expect to get effective treatment. You'll get the bare minimum required to stabilize your condition in the moment then you're out the door. Not sure what you're stanning here.

I have personally seen the opposite -- a relative came into the hospital with no healthcare (even Obamacare which he was 100% eligible for, but simply forgot to sign up for) and got the best possible healthcare. And eventually got retroactively put on Medicare, so that he didn't have to pay.

In any case, people die waiting for service with single-payer healthcare as well. Before you try to reform the system, try to understand how the system actually works rather than just repeating talking points.

Your anecdote does not disprove the general case. If you walk into a hospital dead broke with no insurance with a chronic but not immediately life-threatening condition you're not getting the same level of care an individual would if they had the ability to pay for ongoing treatment. I've got a couple ER nurses I can rope into the conversation that can confirm that if you'd care to try to continue arguing the point.

As far as healthcare reform goes there's nothing particularly complicated about having a multi-billion dollar industry sieve funds that could be better spent on actual healthcare providers. There is also the minor issue of America's medical bankruptcy rates compared against literally every other industrialized nation on the planet, and the small matter of us having both the most expensive (by a wide margin) and one of the least effective healthcare systems of any 1st world country. Again, what the fuck are you stanning over there?

This is an extremely popular liberal talking point. I do not believe it to be true.

The article linked below has it at 60/40. But that's just a simple yes/no survey. When you probe the 40, they are mostly for it too, just with extreme reservations. Talk to some. It's definitely not an 'I got mine, let everyone else die' as is painted.

https://thehill.com/policy/healthcare/3826215-57-percent-sup...

You don't believe it to be true based on what? The fact that it's an extremely popular liberal talking point, or some actual data?

The actual data is closer to 1/3 against than 1/2. Nothing more is usually collected than that vote.

I don't believe, even given revised data above, that even 1/3 are against it. I'd estimate less than 1/5 are against it no matter what. The remainder has doubts and conditions, a given considering how awful government projects usually go. If I thought healthcare would be run like the DMV, I'd vote against it too.

How awful which government projects go? Yeah the DMV is a thing, but so is NOAA and NASA.

Those are good orgs, but not really customer facing ones. Of those people interact with, I can't think of one people actually like. Social Security offices come to mind. And apparently the IRS is impossible to get ahold of, though luckily I've never need to.

I mean why would you want to?

In US there are two useless armies of administrators sucking money out of providing patient's care -- one army employed by insurance industry to deny a claim whenever they can, the other one employed by hospitals and healthcare providers to fight back. It doubles the waste and unproductive work in the best tradition of "bullshit jobs".

I'm a conservative also.

Stuff that basically everyone needs to deal with should be out of pocket with tranparent ahead-of-time pricing. Doctors and occasional specialists, non-exotic meds, normal chronic conditions, etc. State covers/helps it if you can't (means testing with sliding scale, no cliff). Paying for stuff kinda sucks, but less so than brutal waste pulled out of your paycheck or taxes.

Financially major issues could be covered by private insurance or some government plan.

Vaccines subsidized by feds.

Invincibles aren't such a huge problem that we need to twist the whole system around for people who can pay but don't.

Done.

> but less so than brutal waste pulled out of your paycheck or taxes.

Are you suggesting that universal systems are more wasteful? Wouldn't that imply that a simple natural experiment of total healthcare spending vs average health outcomes should show a benefit to private over universal/tax funded?

In the US a lot of tax dollars are wasted on healthcare. A lot more would be wasted if we tried some kind of universal health care in the US.

It seems to me that a lot of waste in this area is tax dollars paying for commercial prices. The US has some truly insane baseline costs in healthcare. Having the state pay for them, or having the state provide an insurer, only kicks the ball into someone else's court.

Figure out why a hospital can charge you $25 for an aspirin, and start there. If you just let the state pay that $25, yes your taxes are being wasted.

  > But even I am for government funded healthcare. Who in the hell is against it?

Anybody who has ever had to deal with Medicaid?

Medicaid in Washington state (Apple Health) is fantastic, all things considered.

The "all things considered" must be doing some heavy lifting in that sentence. Medicaid is almost universally hated by health care professionals. Many places won't take it.

It's a fallacy to claim US healthcare is not "government funded". Aside from that, Canadian wait times for surgery are substantially worse than the United States (even before they stopped necessary surgeries during lockdown). [1]

The amount of Canadians who visit the United States has increased dramatically over the last 10 years, many of which seek services which are simply not available at all in Canada -- such as specialist cancer treatment.

The NHS in the UK, commonly cited as the golden child of government-run healthcare, has the longest wait lists ever with tens of thousands waiting over a year. [2] NHS spending has increased over 6.5% yearly since 2010, with even more massive increases planned for 2024-25.

With the massive NHS spending, UK's nurses and doctors are treated like slave cattle. They earn less than 1/3rd of their US counterparts. This indicates administrative incompetence, skyrocketing middle management, waste and fraud.

[1] https://fee.org/articles/america-outperforms-canada-in-surge...

[2] https://www.bbc.com/news/health-61825071

I find it interesting that whenever socialized healthcare in the US is mentioned, there's always someone eager to point out the failings of Canada's and the UK's systems, yet I never hear mention of any of the other socialized healthcare systems that basically every highly developed nation maintains. I truthfully don't know any statistics on this sort of thing, so I couldn't tell you how good Finland or Greece or Spain are when it comes to healthcare. You'd think there would be relevant criticism to bring up elsewhere if the whole idea is flawed at it's core - otherwise, who cares if Canada's implementation of the concept sucks? Let's learn from their mistakes and others' successes.

Lack of access to doctors is a big issue in Canada. E.g., here's a list of posts on /r/canada about family doctors in the past year: https://www.reddit.com/r/canada/search/?q=family%20doctor&t=...

Canada is almost unique among developed countries with government healthcare in that it doesn't also have a parallel private medical system for those who can afford to pay for it. So naturally rich Canadians will often pay for private healthcare in the US.

I'm originally Canadian but have lived in Australia for the past 10+ years (in Melbourne). We've never had any issues getting medical appointments with local doctors (usually "bulk billed" so we pay nothing or a very nominal amount for the appointment). But we also have private medical insurance, which is required above a certain age (30 something), that we use occasionally for specialist appointments. But even then the out-of-pocket fee is something like $70 which is fine.

Unlike Canada, AFAIK most countries in Europe (e.g., Sweden, France, Spain, Germany) have parallel private medical care, so Canada really is unusual in that respect.

The NHS in the UK is after a decade of sabotage by a Conservative government who would like nothing more than to see it scrapped and replaced with private healthcare insurance like the US has. As it stands it is a system that is being starved of resources and yet it is still outperforming the US.

Can you explain how 6.5%/year increases in budget over 12 years is "starving"? Also curious how you square "outperforming" with the worst ever waiting times for critical surgeries.

> In 2017, the UK spent £2,989 per person on healthcare, which was around the median for members of the Organisation for Economic Co-operation and Development: OECD.

> of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).

> As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

Health care inflation is significantly higher than the retail price index. The population is aging - older people consume far more health resources than younger people.

I'm fairly sure that half a min of extra searching for stats would have turned up number of patients treated over that 12 year period - up 12% excluding covid, which pushed waiting lists up massively.

https://www.kingsfund.org.uk/audio-video/key-facts-figures-n...

TBH I think most of the recent spending has been in management, rather than where it actually needs to be, so that doesn't help.

As mentioned, outperforming here is a relative benchmark vs the US, as stated in the article.

> Can you explain how 6.5%/year increases in budget

Yes! It needs more. Glad to have cleared that up.

> Also curious how you square "outperforming" ...

This is the conclusion of the study in the article you're commenting on

France increased healthcare spending by 0.3%/year between 2010 and 2019.

UK is outpacing France's spending increases by 2,066%. How does the UK need over 20x more spending increases than its close neighbor, exactly?

In 2017 (a year for which I have statistics) France spent 25% more per person on healthcare than the UK.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

The initial claim was that healthcare was being "starved", I don't think 20x more than their neighbors in spending increases is "starved".

Besides, in 2019, the difference was 4% on a per capita basis -- according to World Bank figures. [1] [2] Probably reflecting the massive difference in spending increases.

Given the NHS' planned spending increases from now until 2025, it is very likely the UK will overtake France altogether. NHS spending plans to 2025 that are already agreed outpace inflation by 6 billion pounds.

[1] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat...

[2] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat...

Growing and aging population is the main two.

The Financial Times has published stark data showing persistent underinvestment when Conservatives are in power, compared with peer countries.

> The NHS in the UK, commonly cited as the golden child of government-run healthcare

Except for government clowns, the ones that still claim Brexit was a splendid idea, and people with vested interests absolutely nobody claims that.

At least not since 2008 and austerity when the Tories started wanton destruction of the NHS.

There's a massive drive to private healthcare for those that can afford it and the rest is welcome to eat shit.

Or to wait 25 hours for an ambulance while lying on the floor with s broken hip.[0]

[0] https://www.independent.co.uk/news/health/ambulance-wait-wal...

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